Individual provider Active NPI

Elloren Neadel Davidson, CRNA

  • Certified Registered Nurse Anesthetist
  • Joplin, MO
National Provider Identifier
1366909335
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
2020023489 Issued in MO
Practice address
100 Mercy Way
Joplin, MO 64804-4524
Phone
(417) 781-2727
NPI assigned
Feb 26, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 2012023020 MO
Certified Registered Nurse Anesthetist 367500000X 2020023489 MO Primary

Addresses

Primary practice location

100 Mercy Way
Joplin, MO 64804-4524

Mailing address

3117 Sunset Dr E
Joplin, MO 64804-1359
Phone (417) 521-7003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200821002667 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 3779909635 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northstar Anesthesia of Missouri LLC 88 clinicians

Practice addresses (Care Compare)

100 Mercy Way
Joplin, MO 64804-4524
Phone (417) 556-3729

Hospital & facility affiliations

  • Mercy Hospital Joplin Hospital, Joplin, MO, CCN 260001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
2012023020MOMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of Missouri, LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 20, 2020 Accepting new patients

Locations

100 Mercy Way
Joplin, MO 64804
Phone (417) 556-2300

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1366909335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3117 SUNSET DR E",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041359",
            "telephone_number": "417-521-7003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MERCY WAY",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648044524",
            "telephone_number": "417-781-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "ELLOREN",
        "middle_name": "NEADEL",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-26",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2012023020",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2020023489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joplin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.